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Whipple's Disease Mimicking Sarcoidosis
Pawan Kc1, Frehiywot K Ayele1, Sabin Karki2
1Rheumatology, Emory University School of Medicine, Atlanta, USA.
Cureus
|August 14, 2023
Summary
Whipple's disease, a rare infection, can mimic sarcoidosis with non-specific symptoms like weight loss. Early diagnosis is crucial, especially when standard treatments fail, to identify Tropheryma whipplei infection.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Nephrology
Background:
- Whipple's disease is a rare systemic infection caused by Tropheryma whipplei.
- Increasing awareness is leading to more reported cases, though incidence remains low.
- Classic symptoms include weight loss, diarrhea, and arthralgia, but presentations can vary widely.
Observation:
- A patient presented with poor appetite, weight loss, and granulomatous inflammation mimicking sarcoidosis.
- Initial evaluations showed acute kidney injury, hypercalcemia, and non-caseating granulomas in the spleen.
- Despite treatment for presumed sarcoidosis, symptoms persisted, prompting further investigation.
Findings:
- Renal and splenic biopsies revealed granulomatous inflammation, initially suggesting sarcoidosis.
- Positron emission tomography (PET) scans indicated increased fluorodeoxyglucose (FDG) uptake in the spleen and intestines.
- Small intestinal biopsy confirmed Whipple's disease with positive Periodic Acid-Schiff (PAS) staining.
Implications:
- Whipple's disease should be considered in the differential diagnosis of sarcoidosis, particularly in refractory cases.
- This case highlights the importance of considering Tropheryma whipplei infection in patients with unexplained granulomatous disease.
- Timely diagnosis and appropriate antibiotic treatment are essential for managing Whipple's disease effectively.
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